Credit Card Payment


Instructions

Please complete all sections below. For added security, you will then be directed to our credit card service provider to securely collect and process your credit/debit card information. After you enter your payment information, you will be securely redirected back.

IMPORTANT!

1. Required fields are marked with an asterisk(*). Delays in processing will occur if values are not entered.
2. Do not use the browser back/forward buttons. Your data will not be saved.


1. Information About Subscriber/Applicant

If you are a current subscriber please include subscriber number and group number for faster processing.

2. Type Of Coverage

3. Payment Amount

3. Pull Day


Payments made on the 20th will be made in the month prior. Payments made on the 1st will be made on the first date of the month they are due. Payments that fall on a Sunday or holiday will be made on the first business date following the due date.

4. Contact Information

WPS Health Plan Inc. d/b/a Arise Health Plan
P.O. Box 11625
Green Bay, WI 54307

800-332-6249

Monday-Friday: 8:00 a.m.-4:30 p.m.(CST)

www.AriseHealthPlan.com